Search

Revascularization procedures to treat patients with peripheral artery disease are among the most common operations performed by vascular surgeons. However, there are major limitations to revascularizations, readmission rates due to procedural complications are high, and greater risks of cardiovascular and limb adverse outcomes have been reported for patients with peripheral artery disease undergoing limb revascularization. Specifically, surgical revascularization may be associated with increased generation of reactive oxygen species based on the ischemia reperfusion injury theory, as restored blood flow and reoxygenation of ischemic areas may be accompanied by increased oxidative stress. In this review, we present the current evidence regarding the effects of revascularization procedures on oxidative stress. We also discuss potential therapeutic interventions to prevent ischemia reperfusion injury-mediated tissue damage.

Recent reports, following upon the reported outcomes of European randomized prospective trials of endovascular abdominal aortic aneurysm repair (EVAR), have brought into question the appropriateness of some of the trials' main conclusions, particularly in patients deemed at high-risk for surgical intervention. Based on the data of these trials, specifically EVAR 2, it has been suggested that EVAR should not be performed in high-risk individuals due to the likelihood of poor outcomes and the lack of improved survival, both associated with higher costs. In addition, certain aspects of the trials involving those deemed fit for open repair (the EVAR 1 and Dutch Randomized Endovascular Aneurysm Management trials) deserve qualified reservations. Although prospective, randomized United States trial data on such patients are not currently available, some large retrospective studies and registry reviews provide a basis for comparison of these trials with US EVAR experiences. In this review, the European EVAR trials are analyzed along with these other US studies and the rationale for modifying some of the conclusions drawn from the trials is presented and general guidelines for the selective management of abdominal aortic aneurysm patients presenting with potential indications for intervention are proposed.